Vitamin D deficiency is extremely frequent in chronic kidney disease (CKD) and is associated with
erythropoietin hypo-responsiveness. Hepcidin, the primary regulator of iron homeostasis, may play a
critical role in the response of patients with anemia to iron and erythropoiesis-stimulating agent therapy;
however, the participation of hepcidin to anemia in hemodialysis (HD) patients had not been completely
characterized. To evaluate the relationship between serum hepcidin, indicators of anemia, iron status,
inflammation and 25-hydroxy vitamin D (25-OH D) levels in children with CKD on HD and the impact of
vitamin D therapy on these parameters. This analytical case-control, a double-center study was carried
out on CKD patients attending the Nephrology Unit of the pediatric department at Benha and El
Menofeya University Hospitals. Participants were classified into two groups: Group I Forty patients with
end-stage kidney disease (ESKD) on HD. Group II Thirty healthy children of matched age and sex were
included as a control group. All participants were subjected to full medical history, thorough clinical
examination and laboratory evaluation in the form of complete blood count (CBC), kidney functions, liver
functions, IL-6, serum levels of iron, ferritin, hepcidin and 25-OH D levels by ELISA. All patients received
ergocalciferol as intensive replacement therapy depending on baseline 25-OH D levels for 3 months
followed by maintenance therapy. Pre-treatment levels of study parameters were significantly disturbed
compared to control measures. Hepcidin was significantly increased in pediatric HD patients
(272.7±152.6 ng/ml) when compared with their respective control subjects (39.1±21.8 ng/ml). A significant
positive correlation was demonstrated between serum hepcidin levels and both IL-6 and serum ferritin,
while a significant negative correlation was revealed between serum hepcidin and, Hb, serum 25-OH D
and iron. Post-treatment with ergocalciferol, the serum ferritin, hepcidin and IL-6 levels were
significantly decreased, while Hb level and Hct value were significantly increased compared to pretreatment
levels. These findings suggest that hepcidin may mediate the negative effects on both
disordered iron metabolism and erythropoiesis in HD patients and that Ergocalciferol could be used
therapeutically to reduce hepcidin concentrations and thereby improve erythropoiesis-stimulating agent
responsiveness and reduce inflammatory mediators. |
